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Elder Abuse: The Secret Behind Closed Doors

By Ellen M. Craine, JD, LMSW-Clinical and Macro, ACSW, INHC

According to the National Council on Aging, as many as 5 million older Americans are abused each year. Likely contributing to the potential for abuse is a lack of support and coping tools for family caregivers. In addition, one in 10 Americans aged 60 and older have experienced some form of elder abuse.

Elder abuse is a form of domestic abuse and may include physical, emotional, financial, or sexual abuse as well as exploitation, neglect, and abandonment. Among the physical signs of abuse are bruises, broken bones, abrasions, and clear signs of overmedication. Sexual abuse includes forcing someone to have sexual encounters of any kind. Emotional abuse may include the way someone communicates with the older adult and the sharing of information that should be known to cause harm to the older adult. Neglect may include not providing proper nutrition and/or a proper living environment for the older adult. Financial abuse includes spending the older adults’ money or getting the older adult to give the abuser money under false pretenses—for example, the abuser says it’s needed to pay a personal debt or bill then spends it for their own use.

Elder abuse occurs in adults who are 60 years of age or older.

Risk Factors for Abuse
Among the risk factors that may cause a caregiver to hurt an older adult are the following:

• the caregiver uses or abuses alcohol or drugs;
• the caregiver has high levels of stress and few or inefficient coping resources;
• the caregiver has a lack of social support;
• the caregiver has a great emotional or financial dependence on the older adult;
• the caregiver lacks training in caring for older adults; and
• the caregiver has a history of depression or another mental health issue.

Preventing Elder Abuse
Social work ethics provide some guidelines that may help them guide and support caregivers. They can educate caregivers, for example, about the right older adults have to self-determination. Often, caregivers forget that older adults feel a sense of loss and grief as decisions are being made for and about them. The more the older adult can be included in the decision-making process, the more they can help decrease the older adults’ episodes of depression and anxiety. Other symptoms of grief that are normal include increased anger and frustration, a sense of helplessness, a sense of isolation, and difficulty sleeping, to name a few.

Social workers can help prevent abuse by listening to older adults and their caregivers. If an older adult indicates that they feel overmedicated, for example, trust them. Anything the older adult shares as a concern about how they are being treated by their caregiver(s) needs to be taken seriously. Social workers are mandated to report on actual known and suspected elder abuse to Adult Protective Services. It is important to be educated about how to recognize elder abuse and how the signs of elder abuse differ from the normal aging process.

Tips for elder abuse prevention for caregivers include the following:

• Get help from family, friends, or local respite groups.

• Take a break—even if only for a couple of hours.

• Involve more people than just family in financial matters (an accountant or attorney, for example).

• Find an appropriate day care program.

• Seek counseling or other support if the caregiver is experiencing sadness/clinical depression or anxiety.

• If use of drugs or alcohol is an issue, get help.

One coping or navigation tool is the importance of putting caregiving desires in writing and discussing them with everyone who will have a role in the process ahead of when they are needed. It is important to discuss all of the caregiving roles as laid out earlier in this article so that everyone is on the same page with what those are. The big roles are the hiring and firing of caregivers, medical decisions regarding medical care, making sure the day-to-day tasks are being managed properly, and financial management. These may or may not be similar to the tasks that someone else may need to address, but it is a good bet that everyone caring for an older adult will have to address at least one, if not more, of these tasks. In addition to encouraging older adults to put their wishes in writing, it is important that we put our own wishes in writing about what we want should any one of us ever need any kind of caregiving or medical decisions to be made on our behalf. This includes, but is not limited to, making sure a will and trusts are in place in addition to putting in place durable medical power of attorney(s) and financial power of attorney(s) and spelling out everything in as much detail as possible.

— Ellen Craine is in private practice as a licensed clinical and macro social worker in the State of Michigan and the owner of Craine Counseling and Consulting. She has more than 25 years’ experience working with couples, families, groups, and individuals. She’s a relationship and life coach incorporating success principles with her social work experience and is a social work business and ethics consultant. Craine is a #1 bestselling author of four coauthored books. She can be reached by email at ellen@crainecounseling.com.

Resources for Further Information
• Elder Abuse Helpline and Hotlines: 800-677-1116
• National Center on Elder Abuse: www.ncea.aoa.gov
• National Institute on Aging: www.nia.nih.gov
• National Institute of Justice: www.ojp.usdoj.gov/nij/topics/crime/elder-abuse/welcome.htm
• CDC: www.cdc.gov/violenceprevention